GYNECOLOGIC ONCOLOGY

212-305-3410

Background
Cancer of the vagina cancers occurs in 1 out of every 100,000 women, causing 3% of the female reproductive tract cancers. Most of these cancers do not originate from the vagina, but rather are metastatic cancers from other parts of the body, such as from a cervical cancer.

There are several types of primary vaginal cancer. Cancer of the vaginal lining, termed squamous cell carcinoma, makes up 90% of the vaginal cancers. Melanomas cause 5%. Rare vaginal cancers are cancers of the glandular cells, adenocarcinomas; cancers of the inner tissues called sarcomas; and verrucous carcinoma, a large cauliflower -- like growth caused by Human Papilloma Virus #6. Two very rare cancers found in children are endodermal sinus tumor and sarcoma botryoides. These two cancers arise from residual embryonic tissue. Lymphomas also occur in the vagina.

Risk Factors
Squamous cell carcinomas are caused by persistent infections of Human Papilloma viruses. As with cervical cancer, the risk of getting this vaginal cancer is related to a person's exposure to these sexually transmitted viruses; for example a woman with a history of multiple sexual partners has increased risk. Also, women with a history of condyloma, cervical dysplasia, cigarette smoking, and pessary use have increased risk for vaginal cancer. Sqaumous cell cancers have a precancerous stage, called Vaginal Intraepithelial Neoplasia (VAIN). VAIN lesions show early abnormal features before they are cancerous. VAIN lesions can be diagnosed by gynecologic exams and by Pap/Thin Prep tests. Thus, vaginal cancers can be prevented by finding and eradicating VAIN lesions.

Vaginal cancer became more prevalent in the 1970's when the daughters of women who had been given a drug, diethylstilbesterol (DES), during their pregnancies in the 1950's to prevent miscarriage were found to be developing vaginal clear cell adenocarcinomas early in their lives. Fortunately, the actual rate of these cancer cases was low, affecting only 1 out of every 1000 women whose mothers received DES. A registry was created for these daughters, The Registry for Research on Hormonal Transplacental Carcinogenesis. Many of the daughters have been informed, examined and treated as necessary. Most of these women, now in their 50s, should continue to be monitored for the possible development of a cancer. This adenocarcinoma is associated with the presence of a precancerous condition called adenosis. Adenosis means that the vaginal lining has more than the normal amount of glandular tissue.

Symptoms and Diagnosis
The most frequent signs and symptoms of vaginal cancer are unusual vaginal discharge, persistent itching, vaginal spotting, bleeding after sex, vaginal lump, and an abnormal Pap or Thin Prep test. The cancerous lesion can be an ulcer, an abnormal plaque, or a mass. The lesions are usually found in the upper part of the vagina, however melanomas are found in the lower 1/3 of the vagina. The average age at diagnosis of non-DES-related vaginal cancer is 65. Vaginal cancer spreads directly to adjacent tissues and through the blood and lymph circulation systems.

Diagnosis is made by biopsy of the lesions. The procedure is simple, causes little discomfort, and is performed in a doctor's office. The cancer is staged, that is the extent of the cancer spread is determined, by examinations of the pelvis, the bladder by cystoscopy, and the rectum by proctoscopy. MRI and CT scans can reveal disease involving the lymphnodes. A patient's prognosis is determined by the degree of spread of her cancer when it is diagnosed.

Treatment Methods
Primary treatment is excision of the cancerous lesion. More advanced disease is treated by radiation, chemotherapy, and extensive surgery. The therapy is individualized to maximize a patient's quality and length of life while minimizing treatment complications.

For more detailed information about the staging and treatment of vaginal cancer, please see the National Cancer Institute's website, www.nci.nih.gov/cancertopics, then click on women's cancers, next click on vaginal cancer.